Introduction
Available literature demonstrates that although recruiting, transitioning, motivating, and retaining newly graduated registered nurses (GRNs) exemplify an effective and efficient way through which the nursing workforce needs could be met, admirable results are yet to be achieved in most countries since an estimated 30 to 60% of the GRNs shift from their employment positions within the first year of service (Hatler et al, 2011). The first 3-12 months of the transitioning, according to Perkins (2010), represents a perilous, insecure and stressful time, as the new graduates come in contact with workplace realities which represent fundamentally different priorities and are often in conflict with the idealism of nursing education.
However, as noted by Royds (2010), GRNs can employ reflective practice to learn from the bad and good experiences encountered, mainly by looking at the way these experiences make them feel and react, and then developing positive and empowering themes which will undoubtedly assist them in future practice. Kim (1999) cited in Fejes (2008) argued that “…the goals of critical reflective inquiry are to correct and improve the practice through self-reflection and criticism and [to] generate models of good practice” (p. 243-244). Against this background, this paper seeks to employ reflective practice to demonstrate how key themes of nursing practice, particularly teamwork, delegation, and advocacy, have influenced my transition to practice as a GRN and to my future nursing practice.
Teamwork
From my critical reflections, I have chosen teamwork as one of the professional practice concepts influencing my transition to practice because it assist a GRN to not only learn what care professional colleagues require from them, but also to appreciate the roles of other care professionals in the team and thereby avoid conflict. Teamwork has also influenced my transition in terms of reducing medical errors and getting assimilated into the care delivery process.
Teamwork in nursing is described as “…a dynamic process involving two or more health professionals with complimentary backgrounds and skills, sharing common health goals and exercising concerted physical and mental effort in assessing, planning, or evaluating patient care” (Xyrichis & Ream, 2007, p. 238). In this context, teamwork is critically important to a transitioning GRN because it enables them to not only exercise concerted effort as team members, but facilitates interdependent collaboration, open communication, and shared decision making (Levitt-Jones & FittzGerald, 2005).
The Impact of Teamwork on the Transitioning Graduate Registered Nurse
Within the context of reflective practice, teamwork is viewed as an important attribute in nursing because it ingeniously assists GRNs to realize desirable practice, mainly by reflecting and synthesizing the positive and negative aspects of the attribute to generate a model of good nursing practice that could be used during the process of transitioning and in future practice (Fejes, 2008). Teamwork, according to Cleary et al (2011), provides guided learning experiences, sense of belonging, and clinical and social support that acts to strengthen and expand the knowledge, skills and attitudes for successful transition of a nurse student to practice as a GRN and for future practice.
There exists a multiplicity of positive aspects of teamwork for the GRN, with evidence from research demonstrating effective teamwork as being critical in: determining level of job satisfaction and patient health outcomes (Chang et al, 2009); reducing job-related stress and intention to quit (Yeh & Yu, 2009); reducing levels of medical errors, promoting autonomy, and facilitating decision-making (Xyrichis & Ream, 2007); encouraging sharing of skills and expertise (Donnelly, 2007), bridging cultural barriers (Schriner, 2007); boosting level of morale, and informing the effectiveness, efficiency, and innovativeness of healthcare delivery (Shaw, Lusignan & Rowlands, 2005).
There exist several negative aspects that may occur in teamwork for the transitioning GRN. Lack of skills to manage conflict (Sivamalai, 2008), inter-professional tensions and lack of clear structures and procedures (Simpson, 2007), have been noted as leading hindrances that prevent GRN from transitioning into their fullest potential. Sivamalai (2008) note that the role of being an effective team player for the GRN can also be adversely affected by factors such as “…large team size, lack of familiarity with the team, regular changing of staff in a team, lack of common purpose for the team and the physical layout of the work environments” (p. 9).
The roles and responsibilities of a GRN as a team member revolves around the demonstration of trust and commitment and promotion of collegiality among members (Sivamalai, 2008), demonstration of greater adaptability, productivity and creativity (Simpson, 2007), encouraging more interpersonal communication to learn more clinical competencies and assessment skills from team members (Chang et al, 2009), and contributing to the decision making processes and the advancement of health outcomes (Cleary et al, 2011). The overall impact of teamwork on the GRN transitioning to nursing practice, particularly in reflective terms, is for the GRN to be able to filter all the positive aspects associated with the attribute and develop mechanisms to deal with its stated negative aspects with the hope of developing a good model of practice that could be used in the future to promote quality care to patients (Waters et al, 2009).
Delegation
From my critical reflections, I have chosen delegation as one of the professional practice concepts influencing my transition to practice because it will help the GRN to effectively supervise, evaluate and provide feedback on the delegated tasks. Delegation in nursing is described as “…a primary mechanism for ensuring that professional nursing standards of care reach the bedside” (Corazzini et al, 2010, p. 4). According Carr & Pearson (2005) and Corazzini et al (2010), the concept of delegation is important for the GRN because it enables them to learn diverse activities which are critical to their future nursing practice, such as planning for task delegation, guaranteeing accountability, overseeing performance, assessing performance of delegated duties, and reevaluating and fine-tuning the care plan to achieve optimal outcomes.
The Impact of Delegation on the Transitioning Graduate Registered Nurse
There exist several positive aspects of delegation for the GRN. Indeed, researchers view delegation is an important facet for the GRN during transition and in future practice because it endows them with critical attributes in: making critical patient assessments and nursing diagnosis (Currie, 2008); setting goals and planning level of care (Corazzini et al, 2010); allowing more time to employ nursing skills, spend time with patients, and conduct patient teaching (Standing & Anthony, 2008), and corroborating with other health care professionals (Bittner & Gravlin, 2009). McInnis & Parsons (2009) observe that successful task delegation not only optimizes RN time for tasks that cannot be delegated, but successfully improves satisfaction relative to nurse independence in decision making, and affords a number of promotional openings within the health organization.
Among the negative aspects of delegation for the GRN, Bittner & Gravlin (2009) report that transitioning GRNs are likely to be faced with unclear tasks and role ambiguity in the process of delegating tasks, resulting in excessive fear of making errors in all aspects of their practice and unstable sense of self-confidence. As noted by Hatler et al (2011), GRNs often experience communication barriers and lack of social support that is essential for effective delegation.
Based on the above aspects – both positive and negative – the role and responsibilities of GRN in the delegation process should revolve around development and maintenance of a trusting and respectful relationship (Bittner & Gravlin, 2009), development of effective skill-mix necessary for transitioning and in future practice (Carr & Pearson, 2005), and learning as much as possible from the delegated tasks to allay any fear of making errors and reinstall the much needed sense of confidence (Anthony & Vidal, 2010). The overall impact of delegation in GRN transitioning to nursing practice can be viewed in the context of “…improved nurse’s job satisfaction, reduced burnout, enhanced time management, and clarified accountability” (McInnis & Parsons, 2009, p. 469). These are positive attributes, both during transition and in future practice.
Advocacy
From my critical reflections, I have chosen advocacy as one of the professional practice concepts influencing my transition to practice because it will assist me to not only understand my roles as GRN, but also to assist patients know and understand their rights. Advocacy in nursing can be described “…as an integral part of the nurse’s efforts to promote and safeguard the well-being and interests of his/her patients or clients by ensuring that they are aware of their rights and have access to information for informed decisions” (Vaartio et al, 2006, p. 282). Advocacy is important for the GRN because it enables them to develop attributes that are in line with their professional code of ethics, particularly in the provision of quality care to patients and clients. As noted by Grace (2001) it would be difficult for transitioning GRNs to achieve any meaningful relationships with the patients in the absence of advocacy.
The Impact of Advocacy on the Transitioning Graduate Registered Nurse
Advocacy has many positive aspects for the transitioning GRN, which includes: providing critical information and supporting patients in their decisions (Vaartio et al, 2006); pleading the cause of patients who may not have any leverage to express own feelings (MacDonald, 2007); protecting the patients from unnecessary discomfort or worry (Hanks, 2008); valuing, appraising and interceding for the patients (Grace, 2001); and ensuring quality of care (MacDonald, 2007). As observed by Hanks (2008) and Morrow (2009), GRNs benefit immensely from the triple functions of teaching, education and learning provided by nursing advocacy, particularly in terms of developing role competencies, assertiveness in practice, and level of autonomy. These attributes are essential during transition and in future practice.
In discussing the negative aspects of advocacy for the newly registered graduate nurse, Hanks (2007) underlines “…conflict of interest between the nurse’s responsibility to the patient and the nurse’s duty to the institution where the nurse is employed” (p. 174). In addition, lack of support from the organization and lack of power on the part of the GRN have been identified as possible barriers to effective nursing advocacy. Lastly, lack of the requisite education in advocacy on the part of the GRN, threats of punishment from administration, and a historical barrier on the nursing practice being associated with the feminine disposition, have all contributed towards entrenching barriers to successful nursing advocacy (Hanks, 2007; MacDonald, 2007).
The roles and responsibilities of the GRN in nursing advocacy revolves around ensuring patient needs are effectively met, highlighting discrepancies noted in the provision of care, creating an environment that is suitable for optimal healthcare delivery, and engaging in further education to be an authority in advocacy issues (Grace, 2001; Vaartio et al, 2006). The overall impact of advocacy in GRN transitioning and future practice, as noted by Hanks (2007) and McGrath et al (2006) is the enhancement of patient or client experiences during the provision of care.
Conclusion
From the discussion, it is clearly evident that teamwork, delegation, and advocacy form fundamental themes in my transitioning to practice and in my future nursing practice. It has demonstrated how teamwork will assist in my transition to practice, particularly in respect to developing skills to manage conflict, providing a sense of belonging, as well as clinical and social support, and in assisting me adapt, be productive and creative during transition and in future practice. Delegation, on its part, will assist my transition and future nursing practice in terms of facilitating critical patient assessments and nursing diagnosis, allowing more time to employ nursing skills, and improving job satisfaction levels and autonomy. Lastly, Advocacy as a critical concept in nursing practice will help my transition and future practice in terms of standing for the rights of patients and ensuring quality care. Evidence has also been demonstrated about how the negative aspects of these critical issues in nursing practice can be turned into strengths through reflective inquiry.
Reference List
Agillias, K. (2010). Student to practitioner: A study of preparedness for social work practice. Australian Social Work, 63(3), 345-360.
Anthony, M.K., & Vidal, K. (2010). Mindful communication: A novel approach to improving delegation and increasing patient safety. Online Journal of Issues in Nursing, 15(2), 2-15.
Carr, S.M., & Pearson, P.H. (2005). Delegation: Perception and practice in community nursing. Primary Healthcare Research & Development, 6(1), 72-81.
Chang, W.Y., Ma, J.C., Chiu, H.T., Lin, K.C., & Lee, P.H. (2009). Job satisfaction and perceptions of quality of patient care, corroboration and teamwork in acute care hospitals. Journal of Advanced Nursing, 65(9), 1946-1955.
Cleary, M., Horsfall, J., Mannix, J., O’Hara-Aarons, M., & Jackson, D. (2011). Valuing teamwork: Insights from newly-registered nurses working in specialist mental health services. International Journal of Mental Health Nursing.
Corazzini, K.N., Anderson, R.A., Rapp, C.G., Mueller, C., McConnell, E.S., & Lekan, D. (2010). Delegation in long-term care: Scope of practice or job description? Online Journal of Issues in Nursing, 15(2), 4-12.
Currie, P. (2008). Delegation considerations for nursing practice. Critical Care Nurse, 28(5), 86-87.
Donnelly, G. (2007). The essence of advanced nursing practice. Internet Journal of Advanced Nursing Practice, 8(1), 1-7.
Fejes, A. (2008). Governing in nursing through reflection: A discourse analysis of reflective practices. Journal of Advanced Nursing, 64(3), 243-250.
Grace, P.J. (2001). Professional advocacy: Widening the scope of accountability. Nursing Philosophy, 2(2), 151-162.
Hanks, R.G. (2007). Barriers to nursing advocacy: A concept analysis. Nursing Forum, 42(4), 171-177.
Hanks, R.G. (2008). The lived experience in nursing advocacy. Nursing Ethics, 15(4), 468-477.
Hatler, C., Stuffers, P., Kelly, L., Redding, K., & Carr, L.L. (2011). Work unit transformation to welcome new graduate nurses: Using nurses’ wisdom. Nursing Economics, 29(2), 88-93.
Levitt-Jones, T., & FittzGerald, M. (2005). A review of graduate nurse transition programs in Australia. Australian Journal of Advanced Nursing, 23(2), 40-45. Web.
MacDonald, H. (2007). Relational ethics and advocacy in nursing: Literature review. Journal of Advanced Nursing, 57(2), 119-126.
McGrath, P., Holewa, H., & McGrath, Z. (2006). Nursing advocacy in an Australian multidisciplinary context: Findings on medico-centrism. Scandinavian Journal of Caring Sciences, 20(4), 394-402.
McInnis, L.A., & Parsons, L.C. (2009). Thoughtful nursing practice: Reflections on nurse delegation decision-making. Nursing Clinics of North America, 44(1), 461-470
Morrow, S. (2009). New graduate transitions: Leaving the nest. Joining the flight. Journal of Nursing Management, 17(3), 278-287.
Perkins, D.E.K. (2010). My practice evolution: An appreciation of the discrepancies between the idealism of nursing education and the realities of hospital ratio. Creative Nursing, 16(1), 21-24.
Royds, K. (2010). Using reflective practice to learn from good and bad experiences. Learning Disability Practice, 13(5), 20-23.
Schriner, C.L. (2007). The influence of culture on clinical nurses transitioning into the faculty role. Nursing Education Perspectives, 28(3), 145-149.
Shaw, A., Lusignan, S., & Rowlands, G. (2005). Do primary care professionals work as a team: A qualitative study. Journal of Interprofessional Care, 19(4), 396-405.
Simpson, A. (2007). The impact of team processes on psychiatric case management. Journal of Advanced Nursing, 60(4), 409-418
Sivamalai, S. (2008). Desired attributes of new graduate nurse as identified by the rural community. The International Electronic Journal of Rural and Remote Heath Research, Education, Practice and Policy.
Standing, T.S., & Anthony, M.K. (2008). Delegation: What it means to acute care nurses: Applied Nursing Research, 21(1), 8-14
Vaartio, H., Leino-Kilpi, H., Salantera, S., & Suominen, T. (2006). Nursing advocacy: How it is defined by patients and nurses, what does it involve and how is it experienced. Scandinavian Journal of Caring Sciences, 20(3), 282-292.
Waters, D., Crisp, J., Rychetnik, L., & Barratt, A. (2009). The Australian experience of nurses’ preparedness for evidence-based practice. Journal of Nursing Management, 17(4), 510-518.
Xyrichis, A., & Ream, E. (2007). Teamwork: A concept analysis. Journal of Advanced Nursing, 61(2), 232-241. Web.
Yeh, M.C., & Yu, S. (2009). Job stress and intention to quit in newly-graduated nurses during the first three months of work in Taiwan. Journal of Clinical Nursing, 18(24), 3450-3460.